The relevant factual background;

The Plaintiff (wife ,mother and public servant) had a history of ulcerative colitis with PSC and attended the Inflammatory Bowel Disease (“IBD”) clinic at a regional hospital for a number of years since 2015

Following the birth of her second child in 2018, the Plaintiff began to experience a sharp pain in her side.

By the summer of 2018   the Plaintiff was reviewed by her gastro consultant at the IBD clinic and  they advised the Plaintiff’s GP, that the Plaintiff developed cholestasis towards the end of her pregnancy and that her bowels had been variable over the previous week.  The plaintiffs gastroenterologist consultant, further advised at that time, that the Plaintiff should have yearly colonoscopies, 6 monthly ultrasounds and CA 19.9 tests.as she was now at significant increased risk of developing bowel cancer. However, these annual colonoscopies only occurred haphazardly.

In  November 2018 the Plaintiff’s GP wrote to the gastroenterology department  indicating that the Plaintiff’s recent liver function tests were worse than before and that she was complaining of extra discomfort in the bowel, more bowel frequency, and sometimes joint pains. The letter further requested that the Plaintiff be seen more urgently than her next appointment which was scheduled for the end of January.

The hospitals letter to the Plaintiff’s GP indicated that the Plaintiff’s worsening liver function tests had been noted and an urgent MRCP booked.

By early December 2018 the Plaintiff underwent an MRCP which was noted to show that no dominant stricture had developed and  that the Plaintiff had mild changes of PSC.

At December 2018 clinic. In a letter of  January 2019 to the Plaintiff’s GP the gastroenterologist consultant noted that the Plaintiff’s main problem was urgency and that she had crampy abdominal pain as well as intermittent joint pain and also referred the Plaintiff to a consultant hepatologist.

In early January 2019, the third Defendant carried out a colonoscopy on the Plaintiff at the second  Defendant hospital.  Significant inflammation throughout with rectal sparing was noted.

By  February 2019 the gastroenterologist consultant advised the Plaintiff’s GP that clinically the Plaintiff had increased frequency of bowel motions and was feeling unwell. It was further noted that the third Defendant had carried out a colonoscopy on the Plaintiff, that the Plaintiff’s calprotectin was 225 and she had evidence of active inflammation in her right transverse colon to a more significant degree than her left colon with distal sparing.

In March 2019 the Plaintiff underwent a further review at the IBD clinic in which it was noted inter alia that the Plaintiff had up to 8 bowel motions a day and that the Plaintiff’s cramps and upper GI discomfort were ongoing but had improved.

In May 2019 the Plaintiff was reviewed  in the IBD clinic and it was noted in a letter to the Plaintiff’s GP that the Plaintiff “has ongoing upper epigastric type crampy pain and while it has settled a little on PPI’s, I am anxious about this.” The letter indicated that a gastroscopy, CT of abdomen and pelvis and iron infusion had been organised.

The Plaintiff underwent a CT of the abdomen and gastroscopy early May 2019 at the  hospital. The CT abdomen and pelvis was reported as showing circumferential mucosal thickening of the distal 100mm of terminal ileum as well as mucosal thickening of the caecal pole and proximal ascending colon. It was further noted that there was minimal adjacent inflammatory fat stranding in the right iliac fossa. In mid-May the Plaintiff was admitted to the Accident and Emergency department of the Hospital with stomach cramps, vomiting and diarrhoea. The Plaintiff’s symptoms were originally managed as gastroenteritis with IV fluids and antiemetics but the diarrhoea became a prominent feature and the Plaintiff was commenced on IV steroids in respect of an IBD flare.

In early June 2019, the Plaintiff was admitted to the A & E of the hospital with abdominal pain and diarrhoea and a tender abdomen. A CT of the abdomen and pelvis was carried out in order to investigate a possible stricture or obstruction.  The scan was reported as showing that the small bowel loops were dilated and showed interrupted segments of wall thickening. The majority of the small bowel loops were noted to be fluid filled with the air fluid level noted at the mid ileal loops. Marked thickening, wall oedema and dilatation of the terminal ileum were noted. The Plaintiff’s primary diagnosis was noted as “Crohn’s disease- small bowel disease and right sided colitis” on the discharge summary  completed mid-June 2019. The Plaintiff was prescribed a reducing dose of steroids and was to be followed up in the IBD clinic.

In late June 2019 the Plaintiff was again admitted to hospital from the IBD clinic with abdominal pain and vomiting. A CT of the abdomen and pelvis was reported as showing thickening in the wall of the terminal ileum with dilatation of the small bowel throughout its length. The conclusion was that appearances were most consistent to radius and resultant small bowel obstruction. The Plaintiff’s discharge summary dated of late June 2019 stated that the CT ruled out obstruction but showed active disease, that the Plaintiff was being discharged on prednisolone and would be followed up in the IBD clinic.

In July 2019, the Plaintiff returned to the A & E Department of  the hospital and was noted to have severe abdominal pain, to have been recently discharged with Crohn’s disease, to be vomiting, pale and with a history of bowel obstruction. An abdominal radiograph was carried out which was reported to show a dilated loop of small bowel in the right upper quadrant measuring 4cm.

In July the Plaintiff attended the A & E department of the Hospital and was admitted as an inpatient with a small bowel obstruction. After surgical review the Plaintiff underwent a  laparoscopic right hemicolectomy and end ileostomy for a small bowel obstruction in the terminal ileum due to a malignant stricture. This was subsequently reported as an invasive adenocarcinoma with focal mucinous features, moderately differentiated, 4.5cm, involving the ileocecal valve. Metastatic carcinoma was noted to be present in 6 of 36 lymph nodes.

 The plaintiffs legal claims of negligence

The essence of the plaintiff legal case was that the Defendants (both the hospital and gastroenterologist consultant were sued) were guilty of negligence, in failing to diagnose the Plaintiff’s colonic tumour as soon as was reasonably possible, as a result because of which the Plaintiff has suffered severe personal injuries, loss, damage and expense. Tragically, as a consequence of the defendants negligence, this 33 year old wife and mother of 2 young children was left with incurable bowel cancer with a very poor life expectancy.

The Plaintiff was denied the opportunity of having her cancer diagnosed earlier from 2015 onwards, by the failure to advise and or perform yearly colonoscopies. If the Plaintiff had had a colonoscopy in February 2016 as she should have been advised to do this is likely to have revealed T1N0  colon cancer which could have been treated by right hemicolectomy. T1N0 colon cancer is associated with a 97.4% chance of survival. If the colonoscopy was performed appropriately in 2015 it likely would have shown the presence of a polyp only which would have been simply excised.

Further a last opportunity was missed when the Defendant failed to carry out a total colonoscopy in January 2019 in  that there was a failure to identify the presence of a caecal carcinoma which should have been identifiable during that colonoscopy.

The Defendant ought to have recommended a further colonoscopy within two months of the January 2019 colonoscopy if there was a failure to reach the caecum during the procedure. The Defendant failed to identify the presence of a caecal carcinoma at the colonoscopy in January 2019 because the Plaintiff’s caecal carcinoma which was diagnosed in July 2019 would have been present and evident in January 2019 It was alleged that the Defendant failed to identify the presence of a caecal carcinoma at the colonoscopy in January 2019 because the Plaintiff’s caecal carcinoma which was diagnosed in July 2019 would have been present and evident in January 2019. It was alleged that the caecum may not have been reached during the January 2019 colonoscopy because if it had been reached the Plaintiff’s caecal carcinoma would have been identifiable.

It is alleged that the Plaintiff has suffered a significant loss of chance of survival (greater than 90%) because  the failure to recommend and perform yearly colonoscopies from 2015 allowed the Plaintiff’s disease to develop from a likely polyp in 2015, to a T1 N.0 cancer in 2016,  to a T2 N.0 cancer in 2017 to a T2 or T3 N1b in 2018 to  eventually a pT 4a N 2a colon cancer at diagnosis with a very poor life prognosis.

 Court application to fast track the legal action in view of poor life expectancy;

MBLLF acting with speed applied to the  in January 2022 to court to case manage the proceeding s fix an early trial date (July) and the court granted the application. Its fair to say that the defence lawyers were very sympathetic and cooperated fully with the fast track approach,  while they undertook the relevant investigations with their medical  experts . For this humane approach the plaintiffs legal team expressed their gratitude ultimately to the Court.

Settlement Talks

The defendants in mid- June invited the plaintiff to attempt to settle the case , to which the plaintiff readily agreed This tragic case settled at the end of June 2022 on the following terms:

(a)  Payment to the Plaintiff of the sum of €2 million plus costs such costs to include all or any reserved and discovery costs and all legal costs

(b)   It was agreed and  the Court Order noted the withdrawal of the claim for “Damages to compensate for loss of free services” post the plaintiffs death,  that would have been provided to her family in the future, thus preserving the option of a Civil Liability Act 1961 Part IV action;

(c)   A letter of regret to be provided by both Defendants.

(d)  The settlement of the related case of the husband, for additional substantial damages and costs of his separate action and all legal costs were awarded,

The settlement achieved was a very good one and at least allows the plaintiff some piece of mind that her family will be provided for properly after her death.

SHOULD YOU REQUIRE ANY FURTHER INFORMATION OR ADVICE CONTACT-

Gillian O’Connor, Managing Partner at gillian@michaelboylan.com Michael Boylan at michael@michaelboylan.com; Ciara McPhillips at ciara@michaelboylan.com